Effects of Zikr Meditation and Jaw Relaxation on Postoperative

Pain, Anxiety and Physiologic Response of Patients Undergoing

Abdominal SurgeryAbstractThe surgical experience and hospital environment is an anxiety-provoking event. Pain andanxiety are the most common distressing adverse effects in the early postoperative period.Routine pharmacologic Methods may impair the recovery of patients for their sedative andemetic effects. Therefore, patients relaxation is the cornerstone for a successful post operativepain & anxiety managements and it is among the interventions addressed to improve physiologicresponse. The aim of this study was to examine the effects of zikr meditation and Jaw relaxationon reducing postoperative pain, anxiety and physiologic response. the study hypothesized thatPatients who practiced zikr meditation & Jaw relaxation exercise in experimental group haveless pain, anxiety and physiologic parameter than in control group & pre intervention. The studywas conducted at The findings of the present study showed that patients undergoing surgery whopractice zikr meditation & jaw relaxation have significantly lower subjective indices of anxietyand pain, after following the guideline of Zikr meditation & jaw relaxation practice. However,the study showed that there was no statistically significant difference between the two groups inthe physiological responses. These responses included the systolic and diastolic blood pressure,heart rate, and respiratory rate. These findings imply a possible benefit of such guideline inimprovement of the delivery of efficacious nursing management that decreases pain severity andanxiety for patient undergoing surgery. Therefore, zikr meditation & jaw relaxation therapy couldbe incorporated into clinical practice as a routine nursing intervention before and after abdominalsurgery.Key words: zikr meditation, Jaw relaxation, Pain, Anxiety, physiologic response, abdominalsurgery

Instrumentations:The following tools were utilized to collect data pertinent to study:1. Background data and Medical Information Form: this included sex, age, educational status, occupation,religion, marital status, medical illnesses and history of previous surgery. The medical information formincluded the information of diagnosis, type of operation, type of anesthesia, site of surgical pain, and paincontrol analgesia used.2. Pain rating scale (PRS)This study used a pain rating scale to measure pain; the scale has been widely used to evaluate subjectivePhenomena, such as sensations, perceptions and Reactions. Subjects indicated their degree of pain, using ascale of 010, with 0 indicating the least amount and 10 indicated the greatest amount. This scale has beenfound to be reliable as well as easy and convenient to use. (Wewers & Lowe, 1990). PRS was chosen as ameasurement, tool because it had been regarded as a valid tool in measuring perceptions of pain intensity, itwas suitable for assessing postoperative pain (Coll, Ameen, &Mead, 2004), and it was easy and quick touse in practice by the nursing staff. Reliability the PRS have been reported to be reliable for measuring painWare, Epps, Herr, & Packard (2006) used PRC in pain in the older minority adults and the test-retestreliability coefficient was .87 and it was easy to score and record. In the present study, the researcher didnot test the reliability of the PRC instrument, but the researcher asked post-operative patients to rate theirpain by using PRC. It was found that they could understand and rate their pain& anxiety correctly.3. Hamilton anxiety scaleThe HAM-A was one of the first rating scales developed to measure the severity of anxiety symptoms, andis still widely used today in both clinical and research settings. The scale consists of 14 items, each definedby a series of symptoms, the reported levels of interrater reliability for the scale appear to be acceptable.Each item is scored on a scale of 0 (not present) to 4(severe), with a total score range of 056, where <17indicates mild severity, 1824 mild to moderate severity and 2530 moderate to severe.4. Physiological Data Collection Form:The physiological data collection forms included the details about blood pressure, heart rate, andrespiratory rate The blood pressure and heart rates were measured by using the digital blood pressure. Therespiratory rate was measured by the researcher with a stop watch.Validity:The content validity was established by a panel of ten expertise (five professors nurses and three physicians and twoexperts in Zikr meditation), who reviewed the tools for clarity, relevance, comprehensiveness, understanding,applicability and simplicity for implementation and according to their opinion some modifications were applied.Pilot study:A pilot study was conducted with 3 subjects in order to test the suitability of the explanations in the guidelines. Theresults from the pilot study showed that the 3 subjects could read and understand the process of Zikr meditationpractices and jaw relaxation exercise. The time they spent in practicing Zikr meditation lasted 20 minutes for eachperiod, &10 mim in jaw relaxation. The subjects could also understand and use the VAS &STAI Rating Scale. Thesubjects rated the intensity of pain from 7 to 6 after surgery on day 1 and 6 to 5 on day 2. Procedure A researcherscreened patients preparing for abdominal Surgery from a patient list in the nursing station every afternoon in aneffort to identify potential candidates. Inform the head nurses and staff nurses about the purposes of the researchstudy, the protocol for data collection, and the framework of the study. On the day of admission (1 day beforesurgery), potential subjects who met the inclusion criteria were approached for participating in the study. Theresearcher then explained to the subject the objectives, the procedures for conducting the study, When the subjectsagreed to participate in this study, the researcher gave them a consent form for signing, randomly assigned them totwo groups (experimental & control group). Interviewed them for demographic data form, all subjects were taught touse PRS & Hamilton anxiety scale

Official written permissions to conduct the study was obtained from the Director of Mansoura University Hospital.Verbal explanation of the nature and the aim of the study were performed to medical and nursing staff in surgicalwards. In addition for participants who met the inclusion Criteria, I would explain, in person, the purpose of thestudy, experimental intervention procedures and data collection. Participants were enrolled after written consent wasobtained. The researcher emphasized that the participation is absolutely voluntary and confidential as well asanonymity, privacy, rights and safety of the subjects was absolutely assured throughout the whole study.

Beratnya rata-rata nyeri pada hari 1 (6-8 jam setelah operasi) sebelum dzikir meditasi & rahang relaksasi padakelompok eksperimen adalah 3,85 0,366 dan 3,60 0,598 pada kelompok kontrol. Tingkat keparahan nyeri ratarata setelah dzikir meditasi & rahang relaksasi pada kelompok eksperimen adalah 2,55 0,605 dan 2,30 .224inkelompok kontrol. Ada perbedaan yang signifikan dalam tingkat keparahan nyeri setelah dzikir meditasi & rahangrelaksasi pada kelompok eksperimen dan kontrol (t = 3,468, p <0,01) .Juga keparahan nyeri pada hari 2 (24-30 jamsetelah operasi): The berarti keparahan nyeri sebelum Zikr meditasi & rahang relaksasi pada kelompok eksperimenadalah 2,85 3,25 .587and .639in kelompok kontrol. Ada perbedaan yang signifikan dalam perubahan relatifkeparahan nyeri antara kelompok, (t = 2,062, p <0,01). Juga mean dan standar deviasi, keparahan nyeri setelahdzikir meditasi & rahang relaksasi pada kelompok eksperimen adalah 1,50 0,513 dan 2,05 0,605 pada kelompok kontrol (t = 3,101, p <0,01) (Tabel 2).DiscussionThe surgical experience and hospital environment is an anxiety-provoking event. Despite the use of analgesics,patients may feel anxiety and pain before and after surgery, delaying their recovery. Pi-Chu Lin,(2011). Pain andanxiety are the most common distressing adverse effects in the early postoperative period. Pain management iscrucial for surgical patients to decrease patient discomfort and anxiety. Some studies have suggested that practicingZikr therapy can alleviate perioperative pain and anxiety (Mardiyono, Angraeni, &Sulistyowati, 2007) andpostoperative pain (Sitepu, 2009). Similarly,Ikedo et al., (2007) mentioned that meditation is one of the nonpharmacological strategies that can improve physical health, reduce pain, enhance immune responses, improveemotional well- being, and foster spiritual growth. This is the first study combining zikr meditation & jawrelaxation, technique for patient undergoing surgery.The most notable findings of this study are the marked and constant statistical significant difference in pain severitybefore and after Zikr meditation & jaw relaxation on day 1 (6-8 hours after surgery) and on day 2 (24- 30 hours aftersurgery) (Table 2). However, pain severity in the control group also decreased from day 1 to day 2 after surgery.This may be due to the fact that the pain pattern was worst on post- operative day 1, and then the pain decreasedcontinuously on the following days because the abdominal muscles started recovering (Fongkaeo, 2002; Tyler et al.,1993). Also all the patients in this study were Muslims and they practiced Zikr meditation on the routine basis intheir daily lives. Therefore, Zikr meditation &jaw relaxation proved to strengthen the soul, body, and mind which inturn helped the subjects in control group to reduce the sensation of pain in the first and second day after surgery.However, pain severity in experimental group was significantly lower than control group because the experimentalgroup practiced the program of Zikr meditation & jaw relaxation for 30 minutes longer than the control group.These findings confirm hypothesis(1 ) that suppose patients who practiced zikr meditation & Jaw relaxationexercise have significantly less pain severity postoperatively than would those did not.(pre relaxation & controlgroup.This results is congruent with a study done by Chen et al. (1998) who showed the worst pain severity on post-opday one (scores up to 6), with a mean of 4.and Sitepu. ( 2009) who found that Zikr therapy has been approved toreduce postoperative pain. Similarly Yucha, (2004)& Pellino et al. (2005) attributed to Zikr therapy, thoughts frompain to the remembrance of the God almighty lead to patients feel comfortable and calm (Kakigi et al., 2005). prayerthe most common self-reported means of controlling pain. 13 Kristine L. Kwekkeboom and Elfa Gretarsdottir(2006) emphasized that, Pain distress was significantly lower after jaw relaxation compared to control. Relaxation isvery effective as a treatment strategy for painful and stress-making conditions( Burke, Lemone& Mohn-Brown ,2003). Several studies have shown that relaxation reduces the sensory and emotional dimensions of postoperativepain. In many of these studies the researchers tested the jaw relaxation method and this method has been effective inalmost all of these studies (Roykulcharoen, 2004, Stanton-Hicks, Grass, Cranston Anderson, Choi, Schoolmeesters,et al,.1999, Good, Stanton-Hicks, Grass, Cranston Anderson, Lai, Roykulcharoen, et al. 2001, Good, CranstonAnderson, Stanton-Hicks, Grass,Makii,2002 ,Good, Cranston Anderson, Ahn, Cong, Stanton-Hicks,2005 & Seers,Crichto, Tutton, Smith, Saunders,2008).Results of this study revealed that, there was no significant difference between the two groups in the physiologicalresponses on day 1 and day 2. These responses included the systolic and diastolic blood pressure, heart rate, andrespiratory rate. They were measured either before Zikr meditation &jaw relaxation, at the time of, and after thepractice of Zikr meditation & jaw relaxation. This findings not support the 3 hypothesis which suppose that,patients who practiced zikr meditation & Jaw relaxation exercise have significantly lower blood pressure, respiration& heart rat postoperatively than would those did not. .(pre relaxation& control group). This is congruent withMardiyono et al. (2007),who found that, there were insignificant differences between the control and experimentalgroup (n = 70) in blood pressure, temperature, respiration, and pulse.rd

Opposite findings can be drown from study carried out by Benson who asserted that prayer provides physiologicalresponses, such as decreased heart rate, decreased blood pressure, and decreased episodes of angina in cardiologypatients. Benson 1998. Prayer may bring stress-reducing results, Meisenhelder.2000 such as decrease in bloodpressure or increase in the immune function. Some studies have suggested that exposure to relaxation may improvethe hemodynamic status of patients. Astin, Shapiro, Eisenberg, Forys,(2003) and Pargament,(1997). Similarly,studies reported that practicing meditation decreased the heart rate (Danucalov et al, 2008), the respiratory rate(Arambula. 2001, and blood pressure (Yucel, 2007). In the present study ,the results showed statistically significantdifferences in the anxiety level pre & post practicing intervention(zikr meditation & jaw relaxation ) in experimentalgroup and between the experimental and control groups (p<0.05). The findings is in accordance with 2 hypothesisH.2 patients who practiced zikr meditation & Jaw relaxation exercise have significantly less anxiety levelpostoperatively than would those did not. (pre relaxation& control group).These findings are consistent with Mardiyono et al. (2007) who found that Zikr therapy for 25 minutes can decreaseanxiety in major surgery. Interestingly,Formal prayer has been shown to be an effective way to enhance happinessand physical health (Abdel-Khalek, 2007), alleviate anxiety, and depression among Muslim students, in Iraqi, inKuwait and USA (Abdel-Khalek & Lester, 2007), Relaxation reduces the anxiety and pain by creating the feelingsof self-confidence and self-control and reducing negative feelings and restoring hope and gives patients thepossibility of participating in their improvement and since it is an active coping strategy, it can be used at any time(Wilkie, Kampbell, Cutshall 2000). Some studies have suggested that exposure to relaxation can alleviateperioperative pain and anxiety, ( Jane, Wilkie, Gallucci, Beaton ,Huang,2008)Another study by Heye, Foster,Bartlett, and Adkins (2002) reported that, relaxation techniques reduced anxiety bypreventing pain transmission from reaching the spinal cord and by relaxing muscles. Nonpharmacologic nursingapplications in the postoperative period (relaxation techniques, prayer back massage,cold/hot compresses, etc.) helpthe individual both to attain his/her expectations and to reduce his/ her fear, anxiety, and pain (Gregory,2005).Conclusion:Management of pain and anxiety in surgical patients is an important concern for clinical professionals. The results ofthis study indicate that patients undergoing surgery who practice zikr meditation & jaw relaxation exercise havesignificantly lower subjective indices of anxiety and pain, after following the guideline of Zikr meditation & jawrelaxation practice . The subjects following the practice of Zikr meditation & jaw relaxation ,showed statisticalsignificant difference in pain severity at day 1 (6-8 hours after surgery) and at day 2 (24-30 hours after surgery).However, the result of this study showed that there was no statistically significant difference between the two groupsin the physiological responses on day 1 and day 2. These responses included the systolic and diastolic bloodpressure, heart rate, and respiratory rate. Additionally, the level of anxiety can improved significantly afterimplementation of the zikr meditation & jaw rlaxation. Therefore, zikr meditation & jaw relaxation therapy couldbe incorporated into clinical practice as a routine nursing intervention before and after abdominal surgery.Relevance to clinical practiceClinical practice should include zikr meditation & jaw relaxation Therapy to alleviate pain and anxiety in patientsundergoing surgery.Conflict of interestThe authors declare that they have no conflict of interests.AcknowledgmentsThanks to all patients who took part in the study, to all the nurses and other healthcare staff on the wards involved..FundingNo funding sources were provided.nd